Provider Demographics
NPI:1659631521
Name:SEAN S. LEE, D.D.S., INC.
Entity Type:Organization
Organization Name:SEAN S. LEE, D.D.S., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-660-1277
Mailing Address - Street 1:1000 E WASHINGTON ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-4186
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1000 E WASHINGTON ST
Practice Address - Street 2:SUITE E
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-4186
Practice Address - Country:US
Practice Address - Phone:909-660-1277
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-24
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty